Red Book - Anapylaxis

Question 1

Classify Hypersensitivity Reactions

Answer 1

Type 1 - Immediate hypersensitivty
Type 2- Antibody mediated
Type 3 - Immune complex mediated
Type 4 - Delayed

Type 5 - Idioapathic

Question 2

Describe type 1 reactions

Answer 2

Immediate

IgE mediated

Anaphylaxis
Asthma
Allergic Rhinitis

Question 3

Type 2 Reactions

Answer 3

Antibody mediated

IgG/M and complement

Rheumatic heart
Goodpastures
Autoimmunoe haemolytic anaemia

Question 4

Type 3

Answer 4

Immune complex mediated
IgG and complement

RA
Lupus nephritis

Question 5

Type 4

Answer 5

Delayed

T cells, macrophages

Contact dermatitis
Chronic transplant rejection
Coeliac

Question 6

Define anaphylaxis

Answer 6

Severe, life threatening, generalised

Systemic Hypersensitivity

Divided into ALLERGIC and NON-ALLERGIC

Allergic - implies immunological reaction (IgE)
Histamine —> pro inflam cytoikines, prostaglandins, cytokines
Vasodilation and hypotension/tachy

Non Allergic - Direct drug action causing mast cell and basophil degranulation

Question 7

Signs and symptoms of anaphylaxis

Answer 7

Hypotension
Rash
Bronchospasm

SVR drops by 80% due to histamine

Airway - oedema of tongue/lips/oropharynx

Breathing - Pulmonary oedema

CVS - arrhythmias, syncopes

GI - abdo pain, D,V,N

Question 8

Common triggers

Answer 8

NMBD - Roc, Sux, Atra

Antibiotics - penicillins (beta lactams) - 8% cross react with cephs

Thio

Latex (cross react strawberry and kiwi)

Plasma expanders (Dextrans, starches, gelatins)

Chlorhex/betadine/Iodine contract

Question 9

Old management

Answer 9

STOP OFFENDING AGENT
CALL FOR HELP
ABCDE
Secure airway
Give 100%
Elevate legs, and supine

Adrenaline 50mcg Iv0.5mls of 1:10,000) or 0.5 to 1mg (0.5 to 1 ml of 1:1000)
Saline/fluid bolus 500mls

THEN
Chlorphenaramine 10mg
Hydrocortisone 200mg

Can consider salbutamol,ipratropium if wheeze

Question 10

Blood managements

Answer 10

Take three samples for mast cell tryptases

Immediate
1 hours after
6 to 24 hours after

Question 11

Further actions post event

Answer 11

Refer to Regional Allergy Centre

Report on Yellow Card

Document in notes,, discharge letter and GP

Given patient written record —> need for Medic Alert bracelet

Question 12

Further testing

Answer 12

Skin prick test 4-6 weeks after

RAST - antigen specific IgE antibodies

ImmunuCAP - flurescent enzyme immunoassay
More sensitive than RAST
Detects specific IgE

Question 13

New ALS guidance

Answer 13

Chlorphenarmine and steroids OUT

Give IM adrenaline
Repeat after 5 minutes

If no response move to REFRACTORY algorhythm

Low dose adrenaline infusion (1mg in 100mls saline)
Start at 0.5 to 1 ml/kg/hours
Consider arterial line